The Top 10 Liability Risks Facing Physicians Today
Medical professional liability risk is part of practicing medicine. AMA analysis of 2016-2024 survey data found that 28.7% of physicians had been sued during their careers as of 2024; exposure varied substantially by years in practice and specialty. (Source: https://www.ama-assn.org/about/ama-research/medical-liability-market-research)
The goal of risk management is not to practice defensive medicine or eliminate every possible risk. That is not realistic.
The goal is to identify hazards and design reliable, equitable systems that reduce preventable harm, support clinicians, and learn from safety events. (Source:https://home.ecri.org/pages/top-10-patient-safety-concerns)
The following are ten recurring areas of patient-safety and liability exposure selected for practical relevance; they are not presented as a ranked list.
1. Diagnostic Errors and Delayed Diagnosis
One of the most significant areas of medical professional liability continues to involve diagnosis.
A missed diagnosis does not necessarily mean a physician was negligent. Many conditions present with similar symptoms, and medicine often requires physicians to make decisions with incomplete information.
Documentation supports defensibility, but the safety controls are broader: listening to patient/family concerns, reducing cognitive and system failures, ensuring referral and test-result follow-up, and providing a clear contingency plan.
Documentation should reflect important symptoms, examination findings, diagnostic possibilities considered, tests ordered, and the reason behind the treatment plan.
When the diagnosis remains uncertain or symptoms may evolve, provide safety-netting instructions based on the patient’s risk. Explain the expected course, specific warning signs, when and where to seek additional care, and how pending test results will be communicated. Use teach-back when appropriate to confirm the patient’s understanding.
A simple question can help: If another physician reviewed this chart a year from now, would the reasoning behind the decision be clear?
2. Poor Documentation
The medical record is often one of the most important pieces of evidence in a malpractice claim.
Months or years after an encounter, memories may be unclear. Employees may have left the organization. The patient and physician may remember the conversation differently.
The medical record is the principal contemporaneous evidence of the assessment, decisions, communications, and care provided.
Common documentation problems include vague notes, missing follow-up instructions, incomplete informed consent discussions, copied information from previous visits, and failure to document important patient conversations.
The goal should not be to create the longest note possible.
The goal is to create a clear, accurate, and timely record that tells the story of the patient’s care.
3. Communication Breakdowns
Good communication is one of the most effective risk management tools available to a physician.
It is also one of the areas where healthcare continues to struggle.
Closed-claim analyses consistently identify communication and handoff failures as important contributors to liability events. (Source: https://psnet.ahrq.gov/issue/frequency-and-nature-communication-and-handoff-failures-medical-malpractice-claims)
Patients should understand their diagnosis, treatment options, medications, follow-up instructions, and what they should do if their condition gets worse.
Equally important is communication between healthcare professionals.
A referral does little good if the specialist never receives it. An abnormal test result cannot help the patient if no one takes responsibility for acting on it.
Clear communication and clear responsibility go hand in hand.
4. Failure to Follow Up on Test Results
Ordering a test is only the beginning of the process.
Someone must review the result, determine whether action is needed, communicate with the patient, and make sure appropriate follow-up occurs.
This is an area where simple system failures can turn into significant patient safety and liability problems.
For example, a physician orders imaging that identifies an abnormal finding requiring additional evaluation. The physician reviews the report and assumes the office will contact the patient. The staff assumes the physician handled it.
The patient never receives the message.
Strengthen the closed-loop standard: assign an accountable owner; reconcile ordered, completed, and resulted tests; confirm review and action; communicate results in a way the patient can understand; track recommended follow-up to completion; and escalate overdue items.
If the patient cannot be reached or does not complete recommended follow-up, use a risk-based escalation process, continue reasonable outreach through approved channels, document each effort and clinical significance, and determine whether additional action is warranted under organizational policy.
Closing the loop matters.
5. Informed Consent and Informed Refusal
A signed consent form does not automatically mean informed consent occurred.
Informed consent is a process.
Patients should understand the nature of the recommended treatment or procedure, meaningful risks, reasonable alternatives, and the possible consequences of declining treatment.
The same principle applies when a patient refuses recommended care.
Suppose a physician recommends additional testing because of a concerning finding and the patient declines. The physician explains why the test is important and discusses the potential consequences of delaying evaluation.
That conversation should be documented.
If a poor outcome occurs later, the record should clearly show what was recommended, what was discussed, and what the patient decided.
6. Medication Management
Medication-related events remain an important patient safety concern.
Risk can arise from prescribing the wrong medication or dosage, failing to identify an interaction, overlooking an allergy, or failing to monitor a medication that requires follow-up testing.
Medication reconciliation is particularly important when patients see multiple providers or move between hospitals, specialists, primary care offices, and other settings.
Physicians should also be careful about relying solely on electronic prescribing systems to identify potential problems.
Technology is an important tool, but it does not replace clinical judgment.
Clear documentation of medication changes, patient instructions, and required monitoring can help reduce risk.
7. Handoffs and Transitions of Care
Healthcare is increasingly delivered by teams.
Patients may receive care from physicians, advanced practice providers, nurses, specialists, hospitals, rehabilitation facilities, home health providers, and others.
Every transition creates an opportunity for information to be lost.
Who is responsible for reviewing the pending test?
Who is arranging the follow-up appointment?
Did the primary care physician receive the hospital discharge information?
Did the specialist know the patient’s medication had changed?
Many problems occur not because someone made the wrong decision, but because everyone thought someone else was responsible.
Organizations should clearly define responsibility during handoffs and transitions of care.
8. Telemedicine
Telemedicine has become a routine part of healthcare delivery, but virtual care creates some unique liability risks.
One issue is knowing when a virtual visit is appropriate and when the patient needs an in-person examination.
Providers should have a low threshold for recommending additional evaluation when symptoms cannot be adequately assessed remotely. Document why virtual care was appropriate and why escalation was or was not required.
Documentation should identify that the encounter occurred through telemedicine, patient identity, location, consent, privacy, security safeguards and clearly record the history, assessment, treatment plan, follow-up instructions, and any limitations of the virtual evaluation.
Licensing requirements also matter. Providers offering care across state lines should understand the requirements of the state where the patient is physically located. Before the encounter, verify the patient’s physical location and that the clinician is authorized and appropriately insured to provide the contemplated service there.
Telemedicine is a valuable tool, but the standard of care does not disappear because the patient is on a screen.
9. EHR and Artificial Intelligence Risks
Technology has improved healthcare in many ways, but it can also create new liability concerns.
Electronic health records make it easy to copy information from previous visits, use templates, and automatically populate sections of the chart.
That saves time, but inaccurate information can quickly become part of multiple records if it is not reviewed.
Artificial intelligence is creating another area that physicians need to watch carefully.
AI tools are increasingly being used for documentation, patient communication, administrative functions, and clinical support. Physician interest and adoption are growing rapidly, but concerns about accuracy and reliability remain.
Physicians should treat AI as a tool, not as a substitute for professional judgment.
Clinicians and organizations remain accountable for using AI within applicable law, professional standards, organizational policy, and their respective roles. Review, validate, and correct AI-assisted content before it is used for care or entered into the record.
Review before you sign.
10. Failing to Address Problems Early
Not every bad outcome becomes a malpractice claim.
How the organization responds after an unexpected event can matter.
Patients and families need timely, compassionate, and accurate information. Poor communication following an adverse event can increase frustration and distrust.
First, address the patient’s immediate clinical needs. Promptly report the event through the organization’s safety reporting process and notify risk management and the professional liability carrier as required by organizational policy and coverage terms.
Preserve the original record. Never delete, backdate, or obscure an entry; make any necessary correction or late entry promptly, label it accurately, and follow organizational policy and the EHR audit trail.
Communicate known facts with empathy, acknowledge what is not yet known, and explain that the event is being reviewed. Avoid unsupported conclusions, speculation, or assigning blame before the review is complete.
Do not try to manage a serious event alone. Early involvement of risk management and claims professionals supports an appropriate organizational response, timely communication with the patient and family, preservation of coverage, and support for the clinicians involved.
Risk Management Is an Ongoing Process
There is no single policy or checklist that can eliminate medical professional liability exposure.
Good risk management comes from doing the basics consistently.
Communicate clearly.
Document accurately.
Follow up on results.
Make responsibilities clear.
Use technology carefully.
Address concerns early.
Most importantly, build systems that support physicians rather than relying on everyone to remember every step every time.
Strong systems protect patients, physicians, and healthcare organizations.
Having the Right Insurance Partner Matters
Medical professional liability insurance is another important part of protecting physicians and healthcare organizations.
Healthcare Services Group, through Medical Liability Alliance (MLA), provides medical professional and general liability insurance for physicians, allied healthcare professionals, hospitals, healthcare facilities, and other providers.
MLA currently serves physicians and healthcare organizations in Missouri, Kansas, Arkansas, and Illinois and combines insurance coverage with risk management, patient safety resources, claims support, and educational services.
Medical Liability Alliance also maintains an “A” (Excellent) Financial Strength Rating from AM Best, reflecting its financial strength and ability to meet its ongoing insurance obligations.
